Of patients who die in the hospital, approximately half are cared for in an intensive care unit (ICU) within 3 days of their death. Over three-quarters of deaths that occur in the ICU or shortly after an ICU stay involve withholding or withdrawing life-sustaining therapies and, in the vast majority of cases, it is the patient's family that must make difficult decisions about when to withhold or withdraw such therapies. The ability of physicians and nurses to communicate with families of patients in the ICU about the decisions to use or withhold intensive care therapies is a critical part of good quality care. There has been little empirical research on the quality of this communication or ways to improve it. The specific objectives of this proposal are: 1) to describe the content and process of clinician-family communication about end-of-life care occurring as part of the ICU family conferences; 2) to evaluate the quality of this communication; 3) to examine the reliability and validity of a questionnaire assessing this communication; and 4) to use the information obtained in this study to develop curricula for nurses and physicians to improve the quality of this communication. Our long-term objective is to improve the quality of communication between clinicians and families about end-of-life care and ultimately improve the family's experience and the quality of care received by patients dying in the ICU. To achieve these objectives, we will perform a cross-sectional observational study using both qualitative and quantitative research methods. The qualitative method will be content analysis of audiotapes of family conferences and nurse interviews in academic and community hospital ICUs. The qualitative analyses will be based on the principles of grounded theory. The quantitative methods will involve study of a previously developed questionnaire to assess the quality of clinician-patient communication about end-of-life care that will be adapted for completion by family members and health care providers. We will examine the reliability and validity of this questionnaire and compare it with a scoring system developed from the qualitative analyses. This study will provide important information about the quality of clinician-family communication about end-of-life care in the ICU and will allow future projects to identify and evaluate interventions that will improve this communication. In addition, the development of curricula for improving clinician education about clinician-family communication will make an important contribution to the training of nurses and physicians.